Quality standard

Quality statement 5: Return to work

Quality statement 5: Return to work

Quality statement

Adults who have had a stroke are offered active management to return to work if they wish to do so. [new 2016]

Rationale

After a stroke, adults may have significant disabilities that prevent them from returning to work. Work can contribute to a person's identity and perceived status, has financial benefits, and can improve their quality of life and reduce ill health. Being able to return to work is also a sign that rehabilitation has been successful.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults who have had a stroke are offered active management to return to work if they wish to do so.

Data source: Data can be collected from information recorded locally by healthcare provider organisations, for example, from clinical or service protocols.

Process

Proportion of adults who have had a stroke who receive active management to return to work if they wish to do so.

Numerator – the number in the denominator who receive active management to help them return to work.

Denominator – the number of adults who have had a stroke who wish to return to work.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

a) Quality of life for adults who have had a stroke.

Data source: Data can be collected from information collected locally by healthcare professionals and provider organisations, for example, from surveys of people who have had a stroke.

b) Quality of life for carers of adults who have had a stroke.

Data source: Data can be collected from information collected locally by healthcare professionals and provider organisations, for example, from surveys of carers.

What the quality statement means for different audiences

Service providers (such as community services) ensure that systems are in place for adults who have had a stroke to be offered active management to return to work if they wish to.

Health and social care practitioners offer adults who have had a stroke active management to return to work if they wish to.

Commissioners ensure that they commission services that offer adults who have had a stroke active management to return to work if they wish to.

Adults who have had a stroke and wish to return to work are offered help and support to do this. This should include help to identify and manage any problems that might make it difficult to return to work.

Source guidance

Stroke rehabilitation in adults. NICE guideline NG236 (2023), recommendation 1.16.4

Definitions of terms used in this quality statement

Active management to return to work

Active management to return to work should include:

  • identifying the physical, cognitive, communication and psychological demands of the job (such as multi-tasking by answering emails and telephone calls in a busy office)

  • identifying any problems that affect work performance (for example, physical limitations, anxiety, fatigue preventing attendance for a full day at work, cognitive impairments preventing multi-tasking, and communication problems)

  • tailoring interventions (for example, teaching strategies to support multi-tasking or memory difficulties, teaching the use of voice-activated software for people with difficulty typing, and delivery of work simulations)

  • educating about the Equality Act 2010 and support available (for example, an access-to-work scheme)

  • workplace visits and liaison with employers to make reasonable adjustments, such as provision of equipment and graded return to work.

[NICE's guideline on stroke rehabilitation in adults, recommendation 1.16.4]

Equality and diversity considerations

Services should make reasonable adjustments to help adults with significant cognitive impairment and stroke to stay in work or education or find new employment, volunteering and educational opportunities.

Some adults may be unable to work, so other occupational or education activities should be considered, including prevocational training.